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June 8, 2012

Emergency Contraception: We need an unbiased review of the facts


Earlier this week, the New York Times published an article by science writer Pam Belluck titled "Abortion Qualms on Morning-After Pill May Be Unfounded." The research piece that had been long in the works and its release was strategic, given our national focus on the Administration's contraceptive mandate. Belluck focused on the "mechanisms of action" of Emergency Contraceptives (EC), or what exactly happens when EC's are used. Belluck's thesis? EC's do not prevent implantation and therefore are not abortifacients. Unfortunately, in the process of trying to prove her theory Ms. Belluck left out a lot of critical information that astute readers have every right to know.

Dr. Donna Harrison, a board-certified OBGYN, responded to Belluck's piece yesterday, "NYT Convolution of Facts." I highly recommend reading this piece in its entirety but additionally I am highlighting a few key points below and including quotes from both articles.

1) The research question at hand is specifically Plan B's potential to prevent implantation. Dr. Harrison explains the science behind how Plan B works and then connects this to the heart of the debate. "Plan B is a progestin, a type of progesterone. Progesterone is a hormone that must be in a woman's body for her to be able to allow the embryo to implant and develop the placental connections between the embryo and the mother. But Plan B is a very large dose of progesterone, higher than the woman's body would normally make. It is the effect of that high dose which is under debate."

2) Conflicting Research. There are a number of studies indicating that Plan B prevents implantation and more recently a few studies that do not support this. Unfortunately, however, for Ms. Belluck's readers, her piece makes it sound as though one can act with certainty that Plan B does not prevent ovulation. But Richard Doerflinger associate director of the Secretariat of Pro-Life Activities for the United States Conference of Catholic Bishops (USCCB) had a nice quote responding to Ms. Belluck, "I would be relieved if it doesn't have this effect….So far what I see is an unresolved debate and some studies on both sides." He also noted that because of difficulties in ethically testing the drugs on women, "it's not only unresolved, but it may be unresolvable."

3) Collapsing Plan B and Ella. Plan B and Ella are completely different drugs with very different modes of action. Ms. Belluck created confusion by conflating these two drugs in her piece and made broad claims that would extend to all ECs. According to Dr. Harrison, "lumping together two very different drugs and calling them "morning-after pills" allows for clever confusion of what is known about the mechanism of action of each drug, and the role of progesterone in helping the embryo to implant and sustain the pregnancy."

4) Studies show that Ella can cause an abortion pre and post implantation.

Dr. Harrison noted the following:

"Ella is a second-generation derivative of the abortion drug RU-486, and is equipotent with RU-486 in blocking the action of progesterone at the level of the ovary and endometrium, one of the facts I explain in my paper on this topic. Indeed, if taken before a woman ovulates, Ella will interfere with progesterone action and prevent the egg from being released. But the critically important question is what happens when you take Ella after ovulation. And the answer is clear. Ella blocks the action of progesterone at the level of the ovary, and blocks the action of progesterone at the endometrium, both of which interfere with implantation."

5) Dr. Trussell is, err, chameleon-like. Dr. James Trussell is quoted as a major researcher in the NYT piece and his research is key to the Department of Health and Human Services' ASPE brief on the cost effectiveness of the contraceptive mandate. Dr. Trussell conveniently changes his message about the drug's efficaciousness to fit with the abortion industry's goal du jour. Dr. Harrison makes the following comment, "[a]nd here, abortion proponents speak out of both sides of their mouth. The quote from Trussell in theNYT article was particularly amusing. If you read his previous research papers, sometimes he claims over 90 percent efficacy from Plan B, and sometimes he claims around 50 percent efficacy. Why these differences? Well, as he so readily admits, you can't get numbers of 90 percent efficacy without some sort of post-fertilization effect. So when the issue of mechanism of action is raised, suddenly the efficacy for Plan B gets 'adjusted' to what would be expected from a drug with no post-fertilization effect. But, when issues of funding arise . . . well Plan B becomes much more effective."

6) Intrauterine Devices (IUDs) prevent implantation. Well here is one point that I will give to Ms. Belluck. She acknowledges that certain copper IUDs (yes, included in the contraceptive mandate) can prevent implantation of a newly fertilized embryo. "scientists say, research suggests that … the copper intrauterine device (also a daily birth control method), can work to prevent pregnancy after an egg has been fertilized."

In the end, this conversation requires caution and continued unbiased research. The difference between preventing and destroying life is immensely significant to women who choose to take these drugs. Women have the right to know about all of the scientific research, not merely the research supporting an individual ideology.

Contact: Jeanne Monahan
Source: FRC Blog